Coping responses and cognitive appraisals are important elements of the process of adjustment following traumatic experience (Lazarus & Folkman, 1984; Freedy et al., 1993). They are the factors that facilitate or complicate the adaptation of individuals to highly stressful events and then predict the occurrence of PTS, PTG, or both.
Recent studies emphasized the importance of different coping mechanisms in the development of negative responses of individuals to traumas (Nezu, & Carnevale, 1987; Wolfe, Keane, & Kaloupek, 1993; Amir, Kaplan, Efroni, Levine, Benjamin, & Kotler, 1997). Coping has been defined as cognitive and emotional efforts to manage the internal or external demands of the experienced stressful situation (Folkman & Lazarus, 1980). What is crucial for the adaptation to the experience of a stressful event is the process of struggling with the trauma rather than the trauma itself (Tedeschi & Calhoun, 2004). In other words, the effects of traumatic events on individuals may be positive, negative or the mixture of positive and negative depending on their coping styles (Jang, 2006). In the literature, the role of coping is to mediate the relationship between the experience of traumatic event and the outcome that may either be PTS, PTG, or both of them (Folkman & Lazarus, 1980; Bosson, Kelley, & Jones, 2012).
Coping has been studied generally in two different categories namely; emotion focused and problem focused coping styles (Folkman & Lazarus, 1980). However, in the literature several studies have been conducted and the results of factor analyses revealed different number of types of coping strategies.
Ginzburg, Solomon, and Bleich (2002) examined the relationship between coping styles and posttraumatic stress after myocardial infarction. They found that repressive coping negatively predicted acute stress disorder and PTSD. On the other hand, the findings of the research investigating the relationship between avoidant coping and PTS revealed that the avoidant coping style facilitated the development of PTS symptoms following motor vehicle accidents (Bryant & Harvey, 1995). Similarly, the results of the study investigating the predictors of acute stress following motor vehicle accidents showed that avoidance coping was positively associated with both acute stress disorder and acute stress severity (Harvey & Bryant, 1999). Likewise, another research studying motor vehicle accident victims showed similar findings, stating that avoidance, and self-blame were the risk factors for the development of PTS (Dörfel, Rabe, & Karl, 2008). Moreover, self-blame positively predicted severity of the PTS intrusion subscale; minimization (to devaluate intensity, duration, or importance of stress) coping negatively predicted avoidance and hyperarousal dimensions of PTS. Additionally, situation control coping negatively predicted severity level of avoidance symptoms. However, situation control, (analyze the situation, plan actions, and act) and self-aggrandizement (to attribute less stress to oneself as compared with others) coping styles were reported as protective factors for PTS.
Furthermore, Compas, Connor-Smith, Saltzman, and Thomsen (2001) conducted a review study and they found that problem-focused coping was significantly associated with better adjustment, in other words, lower PTS reactions in the aftermath of the traumatic event. Consistently, the results of the study examining coping responses after a terrorist attack in Norway supported these findings (Jensen, Thoresen, & Dyb, 2015).
Traumatic events challenge the assumptive world and schemas of the individual (Janoff-Bulman, 1992; Tedeschi & Calhoun, 1995). Cognitive appraisals are an important element involved in the adaptation process of individual to the trauma and its effects on this assumptive world. Cognitive appraisals have been defined as a process of evaluating the event personally and trying to understand the meaning of the event for the individual. Rumination plays a crucial role in this process of appraising the situation. The word ‘rumination’ means, “to go over in the mind repeatedly and often casually or slowly” (Merriam Webster Online). In psychology literature, this term was generally used to define negative thinking about self and symptoms (Nolen-Hoeksema, Mc Bride, & Barson, 1997). Cann, Calhoun, Tedeschi, Triplett, Vishnevsky, and Lindstrom (2011) emphasized that despite its common use with the negative meaning, the term rumination also means repetitive thought that ponder on the information. Moreover, rumination is an adaptive process implying that individuals cognitively process and work through their experience.
In the literature, it has been indicated that ruminative thoughts can take two different forms (Watkins, 2008; Cann et al., 2011; Stockton, Hunt, & Joseph, 2011). The first one is intrusive thoughts that are not deliberate and are associated with the symptoms of distress and the second one is more controlled thoughts aiming to make a sense of the event and solve the problem, which is called deliberate rumination.
Different forms of rumination were also named differently. Treynor, Gonzalez, and Nolen-Hoeksema (2003) defined brooding as focusing on the causes and consequences of the negative experience in a way that solving problems becomes impossible because of the passive manner of thinking. On the other hand, individuals using reflective pondering voluntarily engage in adaptive problem solving. Reflective pondering is an adaptive form of rumination that is positively correlated with posttraumatic growth.
Similarly, Cann et al. (2011) defined intrusive rumination as invasions of individual’s thoughts about the traumatic experience. However, deliberate rumination was defined as a volunteer rumination in order to understand the meaning and consequences of the event. Therefore, these two kinds of ruminations that follow the traumatic experience seem to differ in terms of the nature of their relationships with PTS and PTG.
In the current study, the terms of intrusive and deliberate rumination will be used.
Several research findings in the literature supported the positive relationship between rumination and PTS following traumatic events. In other words, repetitive and perseverative thinking about the traumatic event, its causes and consequences have been found to be significantly related to PTSD (Clohessy & Ehlers, 1999; Ehlers, Mayou, & Bryant, 1998; Murray, Ehlers, & Mayou, 2002). Similarly, the results of the study conducted with 185 women diagnosed with breast cancer showed that brooding which was defined as a perseverative and passive focus on negative events or emotions was positively associated with depression, anxiety, and stress (Soo & Sherman, 2015). Moreover, it was revealed that PTSD was significantly associated with compulsion to continue ruminating, occurrence of unproductive thoughts, “why” and “what if” type questions, and negative emotions before and after rumination (Michael, Halligan, Clark, & Ehlers, 2007).
Studies focusing on survivors of motor vehicle accidents revealed consistent results with the findings from different traumatic events in the literature. The occurrence and the perceived severity of PTSD symptoms were found to be positively related with rumination about and suppression of intrusive memories of the accident at 3 months and 1 year following the event (Ehlers, Mayou, & Bryant,
1998). The 3-year follow up study investigating PTSD after motor vehicle accidents supported these findings (Mayou et al., 2002). In line with previous studies, it was indicated that rumination was a significant predictor of PTSD and depression (Ehring, Frank, & Ehlers, 2008).
In this section, the factors associated with PTS and the nature of their relationship were presented in three different groups, namely socio-demographic and personality characteristics, event related factors, and post trauma factors. Being female, and low-income level were found to be positive associates of PTS, whereas perceived social support was found to be a protective factor for PTS. Regarding personality characteristics, neuroticism was positively related to PTS. Additionally, studies showed a negative relationship between agreeableness and conscientiousness, and PTS. In terms of event related factors, findings showed a
positive relationship between perceived severity of the event and PTS. Regarding post trauma factors, intrusive rumination and avoidant coping have been found to be positively related to PTS. Moreover, problem solving coping was found to be negatively associated with PTS.
The occurrence of PTS in the aftermath of traumatic events represents the negative and distressing effects of trauma on individuals. On the other hand, there are also positive outcomes following traumatic event. In the following section, the factors associated with PTG, which represents these positive changes will be examined.